renal cancer

Question 1

key points of renal carcinoma + risk factors

Answer 1

Clear cell renal cell carcinoma is the most common type.
adenocarcinomas–> epithelial cells lining renal tubules.

risks factors:
Male 1.5-2x more likely
older
smoking
urban
dialysis
HTN, genetic disorders )von hippel lindau)

Question 2

signs and symptoms of renal cancer + investigations

Answer 2

only 15% present with the classic triad
loin pain, loin mass, haematuria (most common complaint)

‘B’ symptoms

many are incidental findings.

Ix: bloods- but no spefici tumor marker exists
urinanalysis- invisible haematuria
USS
Gold standard if CTAP pre and post IV contrast.

Question 3

staging of renal cancer

Answer 3

stage 1: less than 7cm and confined to renal capsule
stage 2: bigger than 7cm OR invading renal capsule
3: extending to renal vein, vena caca or 1 local lymph node
4: beyond gerotas fascia, >1 local lymph node, ipsilateral adrenal gland involvement, distant mets.

Question 4

management of renal cancer + prognosis

Answer 4

surgical managment is the mainstay
smaler- partial
bigger - radical nephrectomy

if not fit for surgery- perc radiofrequency ablation, ryotherapy or renal artery embolisation.

chaemo does not work.

immunotherapy can have a role (IFN-a/ IL-2).
some tyrosine kinase biologic agents can help

prognosis:
25% have mets at presentation

nephrectomy 70% at 3 years
60% at 5 years.